Cosmetics as Drugs: A Review of Some of the Reported Harmful Effects of the Ordinary Constituents of Widely Used Cosmetics

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PUBLIC HEALTH REPORTS

VOL. 30 OCTOBER 15, 1915 No. 42

INJURIOUS SUBSTANCES IN FOODSTUFFS.

A MANUFACTURER HELD LEGALLY LIABLE TO A CONSUMER FOE INJURY CAUSED BY
POISONOUS SUBSTANCE IN A BEVERAGE.

The Supreme Court of the State of Tennessee, in Boyd v. Coca Cola
Bottling Works (p. 3095 of this issue of the Public Health Reports),
decided that the defendant was liable to the consumer for injury
caused by a poisonous substance contained in a beverage sold by a
retail dealer in a package sealed by the defendant.

Through the negligence of employees of the bottling works a cigar
stub was left in a bottle which was filled with a beverage and sealed.
The wife of the purchaser was made ill by drinking part of the con-
tents of the bottle. Suit for damages was brought, and the principal
defense was that the bottler was not liable because the purchase was
made from a dealer and not directly from the manufacturer. But
the court held that "when the manufacturer of this beverage under-
took to place it on the market in sealed bottles, intending it to be
purchased and taken into the human stomach, under such circum-
stances that neither the dealer nor the consumer had opportunity for
knowledge of its contents, he likewise assumed the duty of exercising
care to see that there was nothing unwholesome or injurious contained
in said bottles. For a negligent breach of this duty the manufacturer
became liable to the person damaged thereby."

COSMETICS AS DRUGS.

A REVIEW OF SOME OF THE REPORTED HARMFUL EFFECTS OF THE ORDINARY CON-
STITUENTS OF WIDELY USED COSMETICS.

By Martin I. Wilbest, Technical Assistant, Division of Pharmacology, Hygienic Laboratory, United

States Public Health Service.

Of the many and varied abuses of drug products there is none in
which fraud, deception, and a wanton disregard for human health
and even life arc so clearly evidenced as in connection with the manu-
facture, sale, and use of so-called "cosmetics."

While no one can deny that emollient, irritant, and even caustic
drugs, applied as cosmetics, have a legitimate and an important field
209 (3059)

October 15, 19 J 5

3060

of usefulness, the abuse of these same drugs, because of the misleading
claims made in connection with many of the so-called cosmetics of a
proprietary nature, involves a menace that should be recognized and
guarded against.

More than 30 years ago, Tuttle (Med. Kec. 1884, v. 25, p. 257) in
discussing the constituents and general effects of this class of prepa-
rations, said: " It is a reproach to modern civilization that one should
find occasion in this day of enlightenment to raise his voice against
the use of cosmetics."

That this statement is even more applicable to-day than when it
was written is evidenced by the following table compiled from the
publications of the Thirteenth Census of the United States:

Number of establishments engaged in the manufacture of perfumery and cosmetics, the
cost ofmateri Is used, and the value of the product as manufactured, compared with the
population of the United States, exclusive of outlying possessions, during the corre-
sponding period.

[Thirteenth Census of the United States, 1910, v. 8, p. 452, and v. 1, p. 127.)

Year.

Number
of estab-
lish-
ments.

Cost of
material.

Value of

product.

Popular

tion of
United
States.

Year of
census.

1879

67
157
262
429

$1,201,409
2,128,420
3,135,017
5,634,031

$2,203,004
4,630,141
7,087,704

14,211,969

50,155,783
62,947,714
75,994,575
91,972,266

1SS0
1890
1900
1910

1889

1899

1909

The establishments included under the heading "perfumery and
cosmetics" are those engaged principally in the compounding of
perfumes, face lotions, and cosmetics generally, and the list does not
include the many hundred laboratories in which these same prepara-
tions may be compounded as a side line. Including the value of the
product made by laboratories primarily engaged in the compounding
of regular pharmaceutical preparations, a very conservative estimate
of the cost of cosmetic preparations to the consumer would be in
excess of $50,000,000 annually.

Among the preparations usually classed as cosmetics for use on
the head and face we have: Hair washes, hair tonics, hair dyes,
shampoo powders, complexion powders, toilet powders, moth and
freckle lotions, face enamels, toilet waters, toilet vinegars, grease
paints, face creams, liquid enamels, beauty washes, and the many
preparations that are offered as a "skin bleach."

The misuse of drugs in the form of "beautifying agents" is prin-
cipally due to the fact that the Federal and many of the State food
and drug laws do not include preparations made and sold as cos-
metics, unless curative claims are made on the label or in the literature
accompanying the package as proof that the preparation is sold or i3

3061 October 15, 1915

to be used "for the cure, mitigation, or prevention of disease either
of man or other animals."

In only five States and the Territory of Hawaii is the definition of
a drug sufficiently broad to include preparations sold as cosmetics,
but even in these States no provision is made to warn the purchaser
of the presence of harmful or deleterious substances.

The general adoption of the more comprehensive definition of a
drug to include antiseptics, disinfectants, washes, perfumes, and
cosmetics would tend to provide some degree of control over prepara-
tions of this kind and prevent much of the present-day fraud. It
would, however, fail to efficiently safeguard the user unless the list
of drugs to be announced on the label were at the same time extended
to include the many poisonous drugs that are at the present time
falsely labeled "harmless."

As an illustration of the fraudulent practices existing in connec-
tion with the manufacture and sale of toilet preparations it will
suffice to quote the following from recent reports of chemists in
charge of State laboratories :

Barnard, H. E. (Rep. Indiana Bd. Health, 1912, 1914, p. 455):
Eighty-one samples of preparations used as hair tonics, skin foods,
cold creams, mouth washes, and lotions of varying character were
examined. Thirty of the samples were classed as illegal. Seven
contained methyl or wood alcohol.

Newcomb, George D. (Proc. Iowa Pharm. Assoc, 1914, p. 28):
Of the 66 toilet preparations examined 20 contained methyl alcohol.
Among the toilet preparations were the following: Egg shampoo,
hair tonics, bay rum, witch-hazel, toilet waters, Florida water, and
perfume.

The dangerous character of wood alcohol is so well established that
it would appear almost incredible that anyone would dare offer a
preparation containing it for use on the human body. A recent
editorial on the subject (J. Am. M. Assoc. 1914, v. 62, p. 538-539)
asserts that nearly a thousand cases of poisoning attributed to wood
alcohol have been reported in the literature since 1893. Many State
laws, however, specifically permit its use in preparations designed for
external application, and even in States in which such use is illegal
it is difficult to secure the conviction of persons selling preparations
containing it.

Wood alcohol is, however, but one of the many poisonous drugs
that have been found in so-called "cosmetics." Many writers and
investigators have from time to time called attention to the possible
harmful effects of preparations that are sold as beautifying agents,
but up to the present time the problems involved have not been given
the attention they properly deserve.

October 15, 1915 3062

Of the potent drugs of a possibly harmful nature that are used in
so-called "hair restoratives" it will suffice to mention: Lead acetate,
silver nitrate, paraphenylene diamine and resorcin.

The beauty washes and face enamels contain an even more impres-
sive array of dangerously potent drugs, including: Flake white, or
lead carbonate; diachylon, or lead plaster; corrosive sublimate, or
mercuric chloride; calomel, or mercurous chloride; white precipitate,
or ammoniated mercury; pearl white, or bismuth subnitrate; zinc
white, or zinc oxide; Chinese white, or commercial zinc oxide; zinc
soap, or zinc stearate.

The first of the above list, the ordinary white lead of commerce,
is also known as body white, silver white, Dutch white, French
white, London white, Roman white, and China white. It is generally
recognized as the most common cause of industrial lead poisoning,
the prevention or possible abolition of which is attracting the atten-
tion of scientists in all parts of the world. No less than 15 States
have enacted laws requiring the systematic reporting of occupational
intoxications, and in an even larger number of States laws are in
force which are designed to prevent or at least to reduce the number
of cases of industrial poisonings.

Despite the amount of time that has been devoted to the study of
industrial poisons, our knowledge of the various problems involved
is even now incomplete and the ultimate effect of the subacute or
chronic form of poisoning by salts of the heavy metals on the mor-
bidity and mortality of those afflicted is as yet a fertile field for in-
vestigation. Enough is known, however, to show that the list of
industrial poisons is a long one and that the various salts of the heavy
metals are among the more harmful of these many poisons.

To the toxicologist it must appear strange that, notwithstanding
the fact that the toxicity of the so-called heavy metals and their
salts is well recognized, many of these substances are offered and are
widely sold as cosmetics with the claim that the preparations con-
taining them are absolutely harmless.

The absorbability of the salts of the heavy metals and their toxic
properties when absorbed have been known for many years. It has
also long since been recognized that females are more susceptible to
plumbism than males. This is thought to be due to the harmful
effects of lead upon the blood and the blood-making organs of the
body and the greater dependence of females on a normal blood
supply. For this same reason, no doubt, young women are mora
susceptible to plumbism than are those more advanced in years.

In both sexes and at all ages, however, the nature of the injury done
makes cases of poisoning by any of the salts of lead difficult to
recognize, more particularly as the obtainable history is at times
misleading;.

3063 October 15, 1915

Robinson (J. Am. M. Assoc. 1915, v. 64, p. 814-815) reports two
cases of lead intoxication due to skin absorption from a cosmetic.
He expresses the belief that many cases of general nervous debility,
some of insanity, and perhaps some of paralysis are caused by the
use of cosmetics containing lead. Many of the vague and little
understood abdominal pains of women are due to this cause and
abdominal sections have been done because of lead colic.

Sante (J. Am. M. Assoc. 1915, v. 64, p. 1573-1574), in reporting
two additional cases of lead neuritis from cosmetics, expresses the
belief that out of the thousands of girls who use preparations con-
taining lead there must be many cases in which the untoward effects
are not readily recognized as being due to lead poisoning and which
are consequently overlooked. The relative infrequency with which
lead poisoning is diagnosed in women leads one to believe that it
must be often overlooked.

Early in the nineteenth century it was asserted that a zinc dyscrasia
analogous to a chronic lead poisoning may be produced either by
the frequent use of medicinal doses of the agent, by the inhalation
of zinc fumes, or by the absorption of salts of the metal through the
unbroken skin.

While observers have differed in their opinions regarding the toxic
properties of zinc and its salts, it is now definitely established that
occupational brass poisoning or brass founders' ague is due to the
zinc that is present in the mixture and that the several salts of zinc
may produce a form of intoxication simulating that caused by the'Salts
of lead.

It has been claimed by some that patients suffering from zinc
poisoning are even more subject to a general progressive muscular
atrophy than are those suffering from lead poisoning and that the
gastrointestinal symptoms as well as the nervous symptoms are
equally severe.

Acute, subacute, and chronic poisonings by the several salts of
mercury are more readily induced than are the corresponding intoxi-
cations by lead and zinc. Salivation, accompanied by torturing
cramps and nausea, has been caused by. the local use of calomel
and other insoluble salts of mercury and also by weak solutions of
mercuric chloride.

Hydrargyria, or mercury intoxication, begins usually with sali-
vation, accompanied by redness and swelling of the gums, and is
followed by stomatitis, diarrhea, and a marked disturbance of the
central nervous system.

The very common occurrence of mercuric chloride or corrosive
sublimate in the moth and freckle lotions sold at the present time
is deserving of special attention.

October 15, 1915 3064

Mercuric chloride is an efficient local irritant, and properly used
will destroy the outer layers of the skin, and in this way remove
moths and freckles. It is, however, as noted above, also a systemic
poison that may be absorbed through the unbroken skin in sufficient
quantities to cause a chronic, or even a subacute, form of mercurial
intoxication. Used on an open sore or on abnormal skin it may
cause acute and even fatal poisoning.

The insoluble salts of bismuth were long supposed to be compara-
tively innocuous, but their more recent use in connection with X-ray
examinations of fistulous tracts has shown that they may have
toxic properties.

When insoluble bismuth salts are brought into contact with open
wounds soluble compounds are produced that are toxic in character,
producing symptoms similar in nature to those characteristic of
mercurial intoxication.

Tuttle (Med. Rec, 1884, v. 25, p. 258) roports having come in
contact with five cases of poisoning by cosmetics, in which the toxic
agent was undoubtedly an insoluble salt of bismuth. The charac-
teristic symptom was clamminess of the skin, accompanied by
nausea and spasms, differing in degree only from those of lead,
mercury, and zinc.

Even the salts of magnesium are not without possibilities for
harm. Meltzer and Auer have shown that when introduced into
the circulation, magnesium salts aro highly toxic and may produce
kidney lesions, as well as profound respiratory disturbances, and
even death, in warm-blooded animals. Whether or no these sub-
stances can be absorbed through the unbroken skin has as yet not
been demonstrated, but the use of insoluble compounds of magnesia
in dusting powders on open wounds or broken skin i3 not to be
recommended, nor is the long continued use of any of the now widely
advertised lotions containing magnesium sulphate or Epsom salt
advisable.

The latter preparations serve very well to show the gullability of
that portion of the public that is desirous of improving its facial
appearance. As Epsom salt, magnesium sulphato can usually be
purchased for 5 cents a pound, while in the form of any one of the
popular skin or wrinkle lotions it is sold at the rate of from $2 to $4
a pound.

Paraphenylene diamine is an anilino derivative, which by oxida-
tion becomes black or brown. The poisonous qualities of this chem-
ical are well known. A number of cases of poisoning from the use
of the compound as a hair stain and even from wearing hose dyed
with this chemical have been reported.

Ilesorcin is one of the frequently occurring constituents of hair
tonics. In common with other coal-tar derivatives, it is highly

3065 October 15, 1915

toxic, because of the production of methcmoglobin. Some persons
are particularly susceptible to its influence and many cases of col-
lapse and even death from the external use of resorcin are on record.

In conclusion it may be worth while to quote from some of the
published analyses of cosmetics to demonstrate the dangerous char-
acter of many of these preparations and the fraudulent nature of
others.

More than 40 years ago (Am. J. Pharm. 1870, v. 42, p. 362) C. F.
Chandler, in a report stated that of 16 hair tonics, washes, and restor-
atives analyzed 15 contained lead, generally in the form of acetate;
tho remaining preparation contained silver nitrate. Of the 16
preparations reported on by Chandler in 1870, 8 are still sold and 2
wore recently examined by Street (Rep. Connecticut Agric. Exper.
Sta. 1914, p. 281-291). One of these preparations now contains
approximately twice the amount of lead found by Chandler and the
other has been converted into a sulphur-containing preparation with
the active ingredients enumerated on the label. Of the remaining
4 hair restorers examined by Street, 2 contained lead, 1 silver nitrate,
and 1 paraphenylene diamine, the poisonous coal-tar dye referred
to above.

Chandler, in the report previously quoted, states that of 6 lotion3
or washes examined, only 1 contained lead or other injurious metals.
This preparation, a moth and freckle lotion, contained both mercury
and zinc and is still being sold. Street, in the more recent report,
found that out of 7 preparations for the removal of freckles, 4
depended chiefly on the action of mercuric chloride, 1 contained
mercuric chloride and lead and 2 contained ammoniated mercury
or white precipitate.

Chandler, in 1870, found that 3 of the 7 face enamels oxamined
at that time contained zinc oxide, 3 contained lead carbonate and 1
calcium carbonate. Tuttle (Med. Rec. 1884, v. 25, p. 257) found
that 3 of the 8 face enamels examined by him contained lead car-
bonate, 1 contained calomel, 2 contained zinc oxide, and 2 contained
zinc oxide and calcium carbonate.

It may be said that many of the so-called beauty lotions and
toilet powders are primarily fraudulent in that their efficiency may
be questioned and the retail price of any one of this type of prepara-
tion is out of all proportion to the actual value of its components.
Thus Street, in the recent Report of the Connecticut Agricultural
Experiment Station, enumerates no less than 5 preparations for the
removal of wrinkles which were found to consist chiefly of com-
mercial Epsom salt.

An even more recent illustration of deliberate "fraud practiced in
connection with the sale of toilet powders is to be found in a paper

October 15, 1915

3066

by C. H. LaWall (Am. J. Fharm. 1915, v. 87, pp. 293-299). Of 16
samples of rice powder examined, but 2 were genuine and only 6
contained rice starch at all. In 8 of the samples, corn starch
was used in place of the more expensive rice starch, and in 2
samples no starch of any kind was present, the constituents being
wholly of a mineral origin. Talc was present in 13 of the 16 samples
referred to.

The composition of the several samples is well shown by the fol-
lowing table:

Table showing the per cent composition of 16 samples of rice powder, or " poudre de
riz," examined by La Wall.

Number

of
sample.

Rice
flour.

Corn
starch.

Talc

Zinc
oxide.

ChaUc.

Bismuth

sub-
nitrate.

1

100

2 . ..
3

50

40
70
25
93
60
70
75
7
7

38
67
38

10

V!

50

7

ij

25

4

5

6 . ..

7

8

25

18

15

12

25
2
2

9

m

90
62

1

1

10

11

12

33

13

62

14

15

16

100

100
50

25

25

From a study of the available data it may be concluded that —

The poisonous nature of wood alcohol, in all of its several forms,
is so Well established that its presence in cosmetics or other prepara-
tions for external use on the human body should be prohibited by law.

Salts of the heavy metals, particularly salts of lead, zinc, mercury,
and bismuth, may be absorbed from cosmetic preparations and pro-
duce their characteristic constitutional effects.

Women are more susceptible to these several intoxications than
men, and the resulting symptom complex is more likely to be over-
looked or mistaken for a natural physiological disturbance.

Cosmetics, as ordinarily used, tend to clog the pores or irritate the
skin and are thus likely to interfere with the normal, healthy action
of that organ.

To prevent serious intoxications and to preclude obvious deception
and fraud, cosmetics should be classed as drugs and proprietary
preparations sold as cosmetics should be required to state on the
label the name of any poisonous ingredient that may be contained
therein.